January is Glaucoma Awareness Month – How Technology Can Help in Detection & Treatment

“Normally for glaucoma, we’re monitoring pressure two to four times a year with patients coming in every three to six months for a pressure check in the clinic, and it’s just a single spot reading. At home with this device, you get multiple readings over continuous days, so it’s a more accurate representation of their pressure in real life. You can catch spikes in pressure that you might miss from that one in-office check.”

Leo Seibold, MD, Associate Professor of Ophthalmology, University of Colorado School of Medicine
Image Credit: Shutterstock.com

Glaucoma is an age-related chronic optic neuropathy and the leading cause of irreversible blindness worldwide. Predictions report that in 2040 the number of people with glaucoma worldwide will reach almost 112 million, disproportionally affecting Asian and African countries. A significant challenge in trying to tackle glaucoma-related blindness is to identify those with this eye disease before they become symptomatic.

Glaucoma is diagnosed clinically by detecting the characteristic changes of the optic disc and can be confirmed with a corresponding visual field (VF) defect. However, the clinical diagnosis of glaucoma is subjective and relies on the examiner’s experience. A particular challenge for detecting glaucoma is the wide variation of optic disc structure and size in the population. Therefore, there is an urgent need for novel and accurate techniques to detect glaucoma that can be used in different settings.

Fortunately, we are witnessing new practical applications of artificial intelligence (AI), including advances in complex artificial neural networks (ANNs) and constant innovations in daily-used devices such as smartphones, laptops, electronic tablets, wireless communications, etc. Here is a quick review of some new technologies that improve glaucoma diagnosis and treatment.


Tonometry

There are several well-recognized risk factors for glaucoma, including elevated IOP, older age, ethnicity, and family history of glaucoma. Of all risk factors, the level of IOP is the most important one and is the only one that can be modified with treatment. The risk of developing glaucoma rises with increasing IOP. This is supported by the fact that those patients presenting with advanced disease at diagnosis are more likely to have higher IOP. Higher IOP is also a risk factor for disease progression.

Self-monitoring of chronic diseases, such as monitoring blood glucose levels for diabetes mellitus and measuring blood pressure in hypertensive patients, can be effective for informing patients when their current treatment is not sufficiently effective, thereby giving them a sense of control over their condition along with improved disease control. The ability to measure IOP at home throughout different periods of the day will enable physicians to identify potential failures in treatment and possibly improve the prognosis for the patient. The self-monitoring approach could bring significant patient benefits, such as symptom management and improved quality of life.

Peak IOP and IOP fluctuations have been identified as risk factors for the development and progression of glaucoma. Diurnal fluctuations of IOP are highly unlikely to be observed during clinical visits. The Icare home tonometer is based on the principle of rebound tonometry. No topical anesthetic is required, and there is minimal risk of corneal injury. It may be an option for some glaucoma patients to monitor their IOP better at home and aid in managing their condition.

New technologies, such as sensors and wireless devices, present promising tools that enable continuous monitoring of IOP. One of the first platforms used was the SENSIMED Triggerfish contact lens sensor (Sensimed AG, Lausanne, Switzerland). This soft silicone contact lens is provided with a circumferential sensor that consists of 2 platinum-titanium strain gauges designed to measure changes in the radius of curvature of the cornea. A microprocessor transmits an output signal to a wireless antenna on the periocular surface. A cable wire transfers the data to an external portable recorder. The SENSIMED Triggerfish is noninvasive, but the data’s clinical value is uncertain.


Fundal Imaging

Assessment of the damaged optic nerve and retinal nerve fiber layer is a crucial method to detect glaucoma. Stereoscopic fundus examination by an expert clinician is considered standard practice. Automated imaging systems, particularly optical coherence tomography (OCT), are now widely used for glaucoma diagnosis. However, OCT examinations involve high costs, which may not be affordable by some healthcare providers. The advent of digital photography has made it easier and cheaper to acquire and process optic disc images. Nonmydriatic stereoscopic cameras are particularly useful for evaluating the optic disc and helping detect disease progression. Using image processing, relevant features, such as the optic disc and blood vessels, can be analyzed and provide helpful information. Advanced mobile phone technologies enable remote health care delivery and have been proposed as useful tools in glaucoma detection. Newer smartphone devices have high-powered computational functions, cameras, image processing, and communication capabilities, and they have been developed as an inexpensive retinal photography tools.

One example of a successful combination of fundal imaging and smartphone technology is the Portable Eye Examination Kit (PEEK) Retina (Peek Vision, London, United Kingdom), a smartphone camera adapter developed by Bastawrous et al. This portable mobile phone retinal imaging system is low-cost and easy to use for minimally trained users. The PEEK Retina can capture excellent-quality optic disc and retinal images and has recently been validated for optic nerve imaging in population-based studies in the developing world. Multiple other adapters have been developed to convert modern smartphone cameras into fundus and anterior segment cameras, thus reducing their costs and increasing potential adoption. These include the D-Eye system from Italy (D-Eye S.r.l, Padova, Italy) and the Ocular CellScope (Cellscope Inc, San Francisco, CA) from the United States.


Perimetry

Full-threshold automated perimetry (e.g., Humphrey, Octopus) is routinely used to confirm the diagnosis of glaucoma and monitor disease progression. Alternatives to clinic-based standard automated perimetry have been developed, often to facilitate home monitoring. Smartphones and tablets have been shown to be suited for vision testing, and they can communicate with other wireless platforms sending data automatically for analysis.

Although there are substantial challenges associated with home tonometry, including the calibration of monitors (e.g., securing a constant illumination intensity and size of the stimuli), determining the reliability of the test, and maintaining participant concentration, at the moment it is possible to perform VF tests using a tablet-based procedure. In addition to the role of detecting glaucoma, new perimetry technologies using tablets or portable computers have been designed to facilitate patients performing unsupervised perimetric tests as part of a home-monitoring program. Similar strategies have been tried successfully in patients with age-related macular degeneration and with promising results.

The glaucoma screening application called Visual Fields Easy (VFE) is available for the iPad and can be downloaded for free. The VFE showed promising capacity compared with diagnosis based on a Humphrey 24-2 SITA-Standard outcome. The VFE test evaluates 96 test locations (24 per VF quadrant) across the central 30-degree radius in 3 minutes on average, and the testing distance is 33 cm. The test results can be directly printed or emailed using Wi-Fi from the iPad. VFE worked well for identifying moderate-to-severe disease.

Cambridge Consultants has developed a smartphone glaucoma screening technology called Viewi that could be used in a clinic setting or from patients’ homes. The Viewi system includes a smartphone app, a Bluetooth finger button, and a headset that holds smartphones. The smartphone is slid into the viewer, the app is started, and the patient can hold the button in 1 hand, pushing when a light flash is seen. The app runs a suprathreshold static perimetry test. The test results are displayed in an intuitive format on the smartphone and can be shared instantly with healthcare professionals.


Artificial Intelligence

Using ANN and other AI strategies as glaucoma diagnostic tools are becoming a reality. Several techniques have been used to automate the glaucoma detection process. Moorfields Eye Hospital’s collaboration with Google (Alphabet Inc, Mountain View, CA) DeepMind aims to create a general-purpose AI algorithm that can look at OCT scans and diagnose age-related macular degeneration and diabetic retinopathy. VISULYTIX recently introduced PEGASUS (Visulytix Ltd), a new deep learning-based AI technology. It consists of an inexpensive smartphone clip-on optic nerve scanner that looks at several features within fundus images and provides information about the health of the optic disc. PEGASUS can be used not only for glaucoma detection but also for diabetic retinopathy and macular diseases.

Although the number of AI successes in glaucoma will likely grow in the near future, some promising applications are far from their clinical validation. Deep learning AI algorithms might allow the assimilation of multiple composite test results obtained at one screening visit to optimize diagnostic performance at a low cost.


Genetic Testing

There have been an increasing number of genetic studies on glaucoma recently, mainly due to a substantial reduction in the cost of high-throughput genome-wide genotyping platforms. In glaucoma, it seems that genetic testing may be helpful in some circumstances, such as screening of family members in OAG affecting young people with an apparent autosomal dominant inheritance. It has been proposed that genetic testing may help predict conversion from ocular hypertension to glaucoma or help predict disease progression, but the validation of these observations is required. Several international collaborations are currently ongoing, trying to understand the genetic components of glaucoma better. However, at the moment, genetic testing of broader populations is not justified.


New technologies for glaucoma detection have emerged, but their potential value and adoption greatly depend on the setting and the potential use of the test. Possible adoption of teleglaucoma and portable tablet or smartphone-based technologies is expected to facilitate glaucoma detection and management in remote and underserved populations.

Some Observations on Digital Health @CES 2023

“The digital health summit is a very prominent part of the overall experience. We’re starting to see the lines between regulated medical devices and health, wellness, lifestyle devices converge.”

Joel Goldsmith, Director, Digital Platform, Abbott Diabetes Care
Image Credit: Consumer Technology Association

Every January, thousands of “techies” descend on Las Vegas to attend the annual Consumer Electronics Show to see what new things are on display and geek out on the futuristic technologies (some of which will probably never reach the market) that are demonstrated.

Digital health was at the forefront of this year’s Consumer Electronics Show, with notable speakers, announcements, events, exhibitors, and even a startup pitch competition. It isn’t easy to cover all of the products and features shown, but after reviewing all the reporting and checking out some of the companies websites, here are a few that I found interesting.


There was an odd obsession with smart toilets this year – At this year’s show, a quartet of companies is showing off urine analysis tools designed to be used at home by the general public. Most of them are built for your toilet, testing your urine for many easy-to-identify maladies.

The most talked-about gadget at CES was indeed Withings’ U-Scan. The company showed off a device that sits on the dry part of your toilet bowl and samples some of your trickle as you urinate. Once that fluid is captured inside the device, it runs a sample through a microfluidic cartridge (with reaction paper) and uses a reader to look at the result. Once completed, the results are sent to your phone, with suggestions on what you might do to improve your health. When it’s eventually released, U-Scan will offer a cartridge for menstrual cycle tracking, as well as one to monitor your hydration and nutrition levels.

Image Credit: Withings

Korean company Yellosis graduated from Samsung’s startup incubator some years ago and has already produced the Cym Boat personal urine testing kit. At the show, it also showed off its next-generation product, Cym Seat, which uses a metal arm to hold a paper stick under a person as they urinate. Once completed, it slides the strip in front of an optical scanner, and after a minute, the results are pushed to your phone. But this device, expected to launch by the end of 2023 and cost around $1,000, automates the existing process rather than adding anything new.

Vivoo, which also offers a reaction-paper stick that a smartphone app can analyze, is building its own toilet-mounted hardware, which pushes a urine stick into the toilet bowl and then pulls it back in once it’s collected a urine sample. An optical scanner then reads the reaction squares before depositing the stick in a collection bin for disposal later.

Finally, there’s Olive, which is taking a dramatically different tack. The device harnesses spectroscopy rather than reaction paper, with hardware that sits under your toilet seat and a bank of LEDs flashing toward rear-mounted photodiodes. The potential for such a technology is far greater than reaction paper, and some studies have pointed to being able to identify infection with it.

My take – I’m not sure how large the addressable market would be for these smart toilets. There are issues, including around data security, especially for menstrual cycle tracking in countries like the US. Companies that could expose fertility data will need to be mindful of the legal context that is presently in place post-Roe. Will these devices be accurate enough for the jobs they’ve been bought to do? And will the conclusions they provide be worthwhile? There’s a lot to work through before these products become ubiquitous in bathrooms worldwide.


Next is a medical-grade smart ring from Movano. After announcing the Movano ring at last year’s CES, healthcare solutions company Movano Ring upped the ante this year with its new smart ring, Evie. If cleared by the FDA, the ring will be the first consumer wearable that is also a medical device. Evie is designed to give women a full picture of their health, including resting heart rate, period and ovulation tracking, sleep stages, SpO2 levels, skin temperature variability, and more.

Image Credit: Movano Health

“We are bringing together medical grade biometric data and insights in a comfortable and contemporary wearable that allows women to take ownership of their unique health journey.”

Dr. John Mastrototaro, CEO of Movano Health

My take – Movano Health is going after Oura, the market leader in this wearable segment. While it is nothing revolutionary, it is a good step forward in the market of subtle wearable tech. It will be interesting to see how long the FDA process takes – especially since the company is touting Evie as a medical-grade wearable device.


Can taking a selfie potentially save your life?NuraLogix’s Anura app demonstrates the usefulness of a selfie with its technology that can check vital signs using a cell phone camera. The app uses artificial intelligence to offer about 1,000 diagnostics with a 30-second selfie. The diagnostics include heart rate, blood pressure, stress levels, blood sugar levels, and more. The app is available on both the Apple and Google app stores.

Image Credit: NeuraLogix

My take – Despite the claims, there’s a big disclaimer on their website that reads:

Disclaimer image

For Investigational Use Only. Anura™ is not a substitute for the clinical judgment of a health care professional. Anura™ is intended to improve your awareness of general wellness. Anura™ does not diagnose, treat, mitigate or prevent any disease, symptom, disorder or abnormal physical state. Consult with a health care professional or emergency services if you believe you may have a medical issue.


Real-time wearable hydration monitorEpicore Biosystems unveiled its new Connected Hydration sweat patch and mobile app at the 2023 CES. Connected Hydration is the first electronic wearable that continuously measures sweat fluid and electrolyte losses while monitoring skin temperature and movement. To prevent hydration, an alarm goes off on the device when wearers’ fluid loss exceeds two percent of body weight. According to Epicore, the device is intended for people who work in harsh conditions, athletes grappling with extreme heat, and people living through severe heat waves.

Image Credit: Epicore Biosystems

My take – At first glance, this device might appear to have limited market appeal. But the statistics around this problem are staggering. The harmful effects of high temperatures diminish physical and cognitive performance, leading to a staggering 170,000 work-related injuries and 2,000 fatalities annually in the United States. The increasing temperatures also reduce productivity, with total global labor productivity expected to decrease by more than 18% if temperatures rise by 1-3 degrees Celsius. Excessive environmental heat also takes a financial toll, costing employers upwards of $79,000 in worker compensation per affected worker.


Technology to help people with speech issuesWhispp demonstrated its AI-powered smart speech amplifier app and technology. The company’s mobile app converts whispered speech, vocal cord-impaired speech, and severe stutters into a person’s natural voice in real time. This allows users to make themselves heard anywhere while maintaining their freedom of movement.

YouTube Video Credit: Whispp

My take – The technology developed by this Netherlands-based company can aid the more than 500,000 people in the U.S. who have severe issues with voice disorders or stuttering or cancer patients who have difficulty speaking.


Portable virus detector – Opteev Technologies debuted its affordable and convenient breath analyzer, Virawarn. According to the company, the compact and reusable device can detect COVID-19, Influenza, and RSV in less than 60 seconds. Virawarn uses a silk-based biosensor that attracts the electrical discharge of respiratory viruses and an artificial intelligence processor that filters out any potential inaccuracies. Users turn it on, blow twice into the mouthpiece, and an LED notification light will indicate a positive or negative result in under 60 seconds. ViraWarn is reusable and comes with multiple biosensor replacement cartridges that only require being replaced after a positive result or after a period of 2 – 3 weeks of daily usage.

Image Credit: Opteev Technologies

My take – The company just submitted ViraWarn to the US Food and Drug Administration (FDA) for Pre-Emergency Use Authorization (Pre-EUA). Breath is one of the most appealing non-invasive sample types for diagnosing infectious and non-infectious diseases. Exhaled breath is very easy to provide and is less prone to user errors. Breath contains several biomarkers associated with different ailments that include volatile organic compounds (VOCs), viruses, bacteria, antigens, and nucleic acid. Results with COVID-19 detection were highly successful, with 95% Sensitivity and 90% Specificity.


Also, assistive technologies were prominently featured at CES this year. The need for assistive technologies is increasing and is likely to grow due to at least four interrelated reasons: an aging population, increases in the prevalence of disability, increases in the burden of chronic disease, and the corresponding increased load placed on caregivers.

L’Oréal announced plans to release late this year Hapta, a computerized makeup device with motion controls, to help people with limited arm mobility apply lipstick.

YouTube Video Credit: L’Oreal

The Scewo Bro is an adjustable-height wheelchair designed by roboticists and inspired by luxury vehicles. The device is about the same size as a traditional powered wheelchair, but it has two wheels and a pair of tank-like treads for rocky terrain and stair climbing. When approaching stairs, users tap a button. Laser sensors detect how steep the stairs are, and the chair automatically adjusts for the climb. The company tested it with several hundred wheelchair users and tweaked the design based on their feedback.

Image Credit: Scewo AG

Samsung Electronics is adding a mode to new TVs which can outline shapes and content for visually impaired viewers. Relumino Mode is a new picture mode from Samsung that is specially adapted for the visually impaired. When activated, this picture mode highlights contours, lines and colours, making the picture easier to interpret. For a person with normal vision, it may resemble a cartoon-like filter, but for a person with impaired vision, this may be exactly what is needed to decipher and understand the action.

Image Credit: Samsung Electronics

Toronto-based eSight showed its coming wearable for people with vision impairment caused by macular degeneration, glaucoma and other eye conditions.

Image Credit: eSight Eyewear

My take – Older Americans represent a growing audience for assistive technology and fuel a growing demand for increased accessibility in other products. The spotlight on accessible technology also comes as Americans face a financial strain, which might drive people to put “need” purchases over “want” purchases. And while the price tag for innovative assistive devices is often initially too high for many people who need them, startups are trying out subscription payment models for gadgets that insurance won’t cover.


Finally, for a terrific review of the key technologies featured in the age-tech space, I highly recommend this post from Keren Etkin, gerontologist, entrepreneur and author of The AgeTech Revolution – a book about the intersection of tech and aging. Keren’s blog is my go-to resource for all things age-tech related.


2023 looks to be a pivotal year for digital health companies as macroeconomic conditions continue to push investors’ demand for profitability over growth. At the same time, customers (in the form of patients, providers, employers, and insurers) are looking for technologies that prove their clinical worth and deliver seamless care journeys. Point solutions are out of favor as patents, providers, and employers are looking for integrated solutions that combine critical data with analysis tools into a comprehensive data set that reduces costs, improves care provider productivity, and improves clinical outcomes. Companies that cannot provide clear evidence that they can meet these requirements will struggle in this environment.

Time to Expand Remote Sensing Technology Use in Sports?

“It was basically an eye opener for so many parents who have children who love football. Parents might be a little bit more hesitant wanting their child to play if that’s going to happen. It’s unreal.”

Harry Carson, Former Linebacker, New York Giants, on Damar Hamlin injury
Image Credit: Shutterstock.com

On the New Year holiday, while the country was enjoying a half-century-old mass ritual known as Monday Night Football, millions of people – myself included – were left watching Buffalo Bills safety Damar Hamlin fighting for his life near the 50-yard line. As we pray for his recovery, it’s appropriate to ask ourselves: can we, in good conscience, keep embracing this game? And, is there a better way to use real-time technology to monitor the health of athletes in all areas of sport?

Image Credit: Getty Images

People have been wrestling with this question for over a decade, as science has shed light on football’s health consequences. Chronic traumatic encephalopathy (CTE) was once an obscure entry in medical textbooks. Now, it’s the neurological disease associated with repeated blows to the head, known for afflicting more than 300 former NFL players and perhaps hundreds more (the condition can only be definitively diagnosed post-mortem).

“The sport of football is inherently dangerous.”

Kevin Farmer, University of Florida

And Hamlin’s injury is just the most recent example. Hamlin’s injury occurred mere months after Miami Dolphins quarterback Tua Tagovailoa suffered a gruesome concussion-related event when he began seizing on the field following a play—which occurred just weeks after he collapsed due to a separate concussion following a brutal hit in an early season game. In the preseason, the NFL finally tested new helmets designed to prevent concussions. Reports from the league suggest they were effective, but no move has been made to require them in the regular or postseason.

While Hamlin didn’t suffer a head injury (many medical experts suspect his heart stopped due to commotio cordis, an extremely rare but sometimes fatal disruption to heart rhythm resulting from a blow to the chest), it raises the issue of whether real-time monitoring technology can be used more effectively to prevent severe injuries from occurring during games.

A recent peer-reviewed study demonstrates the feasibility of utilizing medical-grade sensors for collecting and monitoring real-time digital biomarkers on elite athletes in live competitions. The peer-reviewed study, Real-time Digital Biometric Monitoring During Elite Athletic Competition: System Feasibility with a Wearable Medical-Grade Sensor, was conducted in professional squash matches in 2019-2020 in cooperation with the Professional Squash Association. The findings demonstrated the capability to reliably capture clinically valid data from medical-grade wearable sensors on athletes exhibiting extreme motion and supraphysiologic characteristics in live competition.

“There is a clear extrapolation to other sports, athletes and venues, but more importantly, the opportunity for real-time observations, reactions, adjustments, refinements of performance, and ultimately predictions derived from sensor data,”

Giulio Bognolo, M.D., Chief Medical Officer and Head of Human Data Labs, SD Labs

In professional team sports, collecting and analyzing athlete-monitoring data are standard practices to assess fatigue and subsequent adaptation responses, examine performance potential, and minimize the risk of injury or illness. GPS trackers sewn into athletic uniforms feed back real-time information on NFL players’ balance, speed, acceleration, and motion. Early signs of injury to soft tissues are readily detected, letting coaches relieve players before serious problems arise. Impact monitor stickers attached to players’ bodies alert coaches and trainers to invisible signs of potential concussion, brain trauma, over-exertion, or injured muscles, tendons, and ligaments.

But that assessment happens during practice sessions and during the recovery period following the actual game itself. The groundwork has been done with the NFL linking up with Zebra Technologies to add monitoring tags to the shoulder pads of all players. The real game-changer will be when this data is made available to coaches during live matches. Is there a case to be made that real-time monitoring should be incorporated into the game? I think we’re at a point where the usual arguments put forward against it are disappearing.

Image Credit: Zebra Technologies
  • Cost – The cost of real-time medical-grade sensors has dropped exponentially over the last five years. And for professional sports teams, where billions of dollars are spent each year, the costs are a pittance.
  • Size & Weight – Sensors and devices for athletes must be almost invisible and weightless, as well as flexible, durable, and impact resistant. Medical grade sensors today are smaller than ever, and their weight is negligible – especially if they are incorporated into clothing.
  • Interference with performance – Today’s medical grade sensors can be easily incorporated into the player’s uniforms and have minimal impact on performance.
  • What they are measuring must be accurate and actionable – Devices already in use are measuring over one hundred human metrics, including heart rate, metabolism, stress load, core temperature, and physical impact from trauma. Researchers are forging ahead, designing devices that will be available soon to more accurately measure hydration levels and deeper aspects of physical stress and metabolic function
  • Player privacy concerns – Many argue that understanding an individual player’s performance stats, physical challenges, and recovery times could be used in contract negotiations, trade talks, and performance incentives. Just as in healthcare, some privacy regulation (like HIPAA) needs to be in place and enforced.

Sports teams are quickly learning how wearable sports technology can improve their team’s performance and save players from injury and illness. But we must take advantage of today’s technology to better protect these elite athletes during the game. In professional sports, where billions of dollars are spent annually, the cost of implementing real-time, in-game monitoring for all athletes is a pittance. And as we experienced on Monday night, it only takes a few seconds for it to stop being a game—and start being about life and death.

Health Care Disruptors to Watch in 2023 – It’s Not About The Technology This Year

“Trust me, you can’t change anything without causing some degree of disruption. It’s impossible, that is exactly what change is. Some people are uncomfortable with the disruption that change causes, but the disruption is necessary if anything is going to change.”

Afeni Shakur, American Activist
Image Credit: Shutterstock.com

“Old habits die hard”

Anonymous

After nearly twenty years of debating which technologies will significantly impact the coming year, the exercise almost becomes a part of your professional DNA. So, in Q4 every year, I start looking at all of the Tech Trends for the next year and thinking about which will rise to the top of my list. But this year is different in so many ways. 2022 was a very strange year. The stock market plummeted, interest rates rose, and inflation skyrocketed, creating problems for companies across all stages of growth. Healthcare companies weren’t immune as VC funding plummeted, and purchases by health systems were deferred to preserve scarce capital.

Image Credit: CB Insights report State of Digital Health, Q3, 2022

To be clear, there was no shortage of technological innovation in healthcare in 2022. Just read any of my weekly Tech News posts, and you’ll find dozens of companies creating innovative digital health solutions to many pressing problems providers face in caring for patients and their families. What has changed is the market we’re operating in. There are several reasons for the change.

We’re coming out of year three of the pandemic, and health systems are still under pressure to care for patients. For over three years, daily, under exhausting and often dangerous conditions, healthcare workers across the country have continued to care for the nation’s sickest Americans who have fallen victim to coronavirus. The burden on the health care system is made worse by nationwide staffing shortages and hospital capacity at elevated levels as many other patients seek care for non-virus-related reasons. As we close out the year, the “triple-demic” of COVID, seasonal flu, and RSV infections (especially in children) is straining the health system to its limits again.

More than half of U.S. health systems will be operating in the red in 2022. According to reporting from Kaufman Hall, More than half of U.S. hospitals (53%) are projected to have negative margins for the rest of the year. Under more pessimistic scenarios, more than two-thirds of hospitals (68%) could have negative margins this year, their report stated. Hospitals have been confronting much higher expenses this year. Hospitals’ expenses are projected to rise $135 billion in 2022, compared to the previous year, according to the report. Labor accounts for the bulk of the increase, a projected $86 billion, with non-labor expenses rising $49 billion.

The top three issues for health system executives and boards are staffing, staffing, and staffing. Hospital leaders in multiple interviews all said they are struggling to find talent. The labor shortages are forcing hospitals to close beds and scale back some services. Hospitals are seeing longer waits in emergency departments, and surgeries and other procedures are being delayed.

“The crisis is real. The shortage of healthcare workers is nothing like we’ve seen before.”

Mike Slubowski, President and CEO of Trinity Health

So, the disruption in healthcare in 2023 comes from these three drivers and will challenge innovators to come up with solutions for several major issues:

Cybersecurity and Ransomware attacks remain top of mind for health systems in 2023. Hospitals, pharmacies, care centers, and other healthcare organizations are prime targets for malicious cyber-criminals. There are a few reasons for this: healthcare organizations deal with vast amounts of personal and private data, which can be hugely valuable for criminal groups. Healthcare organizations often cannot afford to invest in the latest and greatest security technologies, making them an easy target for every type of cybercrime, from gift-card scams to sophisticated ransomware. Exacerbating these issues, the healthcare industry has been under immense pressure over the past three years, dealing with unprecedented challenges during a worldwide pandemic.

“We have to realize that cybersecurity isn’t just about data security; it’s also a matter of life and death.”

Michael Archuleta, CIO, Mt. San Rafael Hospital and Clinics, Trinidad, Colo.

Cybercriminals have cynically exploited the COVID-19 pandemic. The healthcare sector is on track to meet or exceed the more than 50.4 million patient records breached in 2021. Since cyber threats only seem to be getting worse, healthcare executives are planning on increasing their cybersecurity budgets for increased training and infrastructure in 2023 to fend off these kinds of attacks, according to a recent survey from software firm Ivanti. It has been estimated that over the next three years, healthcare-related data breaches will cost healthcare companies a total of $6 trillion. Healthcare organizations will spend $125 billion on cybersecurity from 2020 to 2025.


Addressing staffing and capacity constraints drives broader adoption of command centers in health systems. In the past half-decade, command centers have been gaining ground as permanent fixtures in healthcare organizations — a sort of air traffic control for patient care. When the COVID-19 pandemic hit, health systems with command centers up and running were well-positioned to deal with the overwhelming demand for care, providing hospitals with real-time insight into bed availability, staffing levels, and patient journeys. Health systems with command centers have real-time visibility into staffing levels, which can improve coordination between care teams and break down silos. Staff will appreciate the efficiencies command centers can bring. For example, patients who can be discharged aren’t left lingering in beds, and rooms can be cleaned more quickly. This level of coordination requires well-designed communication channels across departments, ultimately improving processes systemwide.

With the incorporation of remote solutions, these command centers can offer an opportunity to combat clinician burnout. If integrated with a virtual nursing program, for example, overextended nurses might rotate off the floor and remotely support newer nurses at the bedside. In this way, newer nurses benefit from the older nurses’ years of experience, and older nurses get a better work-life balance. Imagine how that translates into improvements in employee satisfaction and clinical outcomes.


“Nice-to-have” solutions go on the back burner. “Mission-critical” solutions get attention. 2023 will not be a year where buyers take chances on unproven technology. Startups need to sell solutions that solve problems in the short term and figure out a way to prove they can do that as quickly as possible. Getting an executive team to act on sourcing a digital solution means making a solid case around how the solution either reduces costs, increases revenue, increases staff productivity, or improves clinical outcomes. I’ve found this equation developed by Alex Lindsay of Office Hours Global to be an effective way to discuss that concept with startups (who are often frustrated by the length of time it takes for a healthcare executive team to make a decision) looking to sell their solutions into healthcare.

Image Credit: Henry Soch, of an equation developed by Alex Lindsay

The gist of the equation is that action occurs when the vendor can demonstrate that the possibilities when implementing the solution exceed the current circumstances. What does that mean in today’s healthcare market?

Health systems that are bleeding cash are primarily looking for anything that supports payment, ideally upfront, or any tools that reduce burnout or help them solve the ongoing staffing crisis. On the other hand, employers are increasingly looking to whittle down their digital health vendors, particularly when utilization is low and outcomes are still to be determined.

So what technologies will get an audience with C-Suite Executives in 2023? Christina Farr from Omers Ventures expects the essential products that will sell well next year to include: Revenue cycle management tools, anything in labor/staffing, and solutions for burnout.


So, this year I’ve taken a different approach to characterize disruptors to health care in 2023. Such exercises are always interesting but also inherently risky – particularly in uncertain times like those we have recently experienced and continue to live through. So perhaps the most significant benefit of the annual round of tech soothsaying is not so much the fine-grained detail – often derailed by contact with unexpected events – as the chance to take stock of the industry’s general direction. These are my educated and informed predictions based on the current situation. I’ll revisit them at the end of 2023 to see if they came to pass. Happy New Year!

How Digital Technologies Can Support Breast Cancer Awareness – Breast Cancer Awareness Month – October, 2022

“Please get your annual mammogram. I was six months late this time. I shudder to think what might have happened if I had put it off longer. But just as importantly, please find out if you need additional screening.”

Katie Couric, Journalist
Image Credit: Shutterstock.com

Katie Couric was diagnosed with breast cancer over the summer and subsequently underwent surgery and radiation treatments that finished this week. In the personal essay and on her essay and on Instagram, Couric, who is 65, shared information about the prevalence of breast cancer. “Every two minutes, a woman is diagnosed with breast cancer in the United States. On June 21st, I became one of them,” she wrote in a social media post shared Wednesday morning. “As we approach #BreastCancerAwarenessMonth, I wanted to share my personal story with you all and encourage you to get screened and understand that you may fall into a category of women who needs more than a mammogram.”

Today, there are more than 3.5 million breast cancer survivors in the United States, with 268,600 new cases expected to be diagnosed this year alone. With an estimated 89% of United States online and 72% owning smartphones, digital health technologies are uniquely situated to bridge the gap in breast cancer care through detection, intervention, and management. As we begin Breast Cancer Awareness Month, I wanted to dig deeper into the current developments and highlight some of the most promising digital health solutions to promote early detection and improve patient care for breast cancer patients and survivors.


Breast Cancer Apps – One of the most stabilizing things you can do with a breast cancer diagnosis is to get the correct information. In addition to your doctor, the right app can be a great place to find answers to all your questions. It can also offer access to a supportive community that understands what you’re navigating. Here are some of the most highly recommended apps based on their quality content, reliability, and user recommendations:

Breast Cancer Healthline – Those who are newly diagnosed, receiving treatment, or in remission will find support and camaraderie in the app’s one-on-one chats and group discussions. This is a place to find and receive advice, access current news and research, and connect with people who genuinely get it.

Cancer Therapy Advisor – An app designed for oncology professionals, Cancer Therapy Advisor compiles the latest in oncology news and trends, cancer treatment regimens, full-length features, slideshows, case studies, and drug information for various cancer types.

BELONG Beating Cancer Together – This free app helps get you access to the best care without a high cost of entry. You can directly communicate with researchers, experts, and other medical professionals who can give you quick, accurate responses to your pressing questions about breast cancer. You can also keep all your records within the app and share them with your doctor and your loved ones, too. You can browse and sign up for clinical trials and access leading oncologists, radiologists, researchers & nurses to answer your questions.

OWise Breast CancerOWise is an accredited mobile app and website that helps you regain control of your life from the first day of a breast cancer diagnosis. OWise provides safe, reliable, and credible information and practical support and guidance. You can monitor and share changes in your day-to-day well-being with your care team or other trusted individuals. This way, you can help your doctors to make timely and informed decisions on how to give you more personalized care.

Mammosphere – Life Image is the creator of Mammosphere. This breast imaging and cancer prevention application lets patients digitally transfer records to and from health care providers at the click of a button. 1 in 4 patients fails to gather their records promptly, skyrocketing the risk of being called back for additional testing or receiving a false positive. Life Image, based in Newton, MA, reduces the number of false positives for breast cancer by up to 60% and drives up patients’ chances of receiving an efficient and accurate diagnosis.

UntireUntire, founded by Door Vonk, is an app that provides cancer patients and survivors with the tools to cope with extreme fatigue. As a result of cancer, its medical treatments, and the emotional and social impact of such a severe illness causes patients to suffer from severe fatigue. Developed by psychologists with the contributions of patients and researchers, Untire uses scientifically proven theories and mindfulness-based techniques to increase cancer patients’ energy and improve their lives. With less fatigue, cancer patients can fight cancer without sacrificing their enjoyment of life.

Savor Health – By leveraging a team of oncology nutrition experts and the latest technology, Savor Health—founded by Susan Bratton—designs individually personalized nutrition solutions to meet the unique needs of cancer patients at every step along their journey. This innovative technology utilizes deep learning models to promote algorithm-driven meal, content recommendations and nutritional counseling through a team of oncology credentialed registered dietitians and nurses.


A.I. and Clinical Decision Support

PathAIPath AI, founded in Boston, MA, utilizes artificial intelligence and machine learning technologies to improve the accuracy and speed of pathologist diagnoses and ensure patients get the correct diagnosis and the most effective treatment.

MIT Computer Science and AI LabMassachusetts Institute of Technology’s Computer Science and Artificial Intelligence Lab developed a new deep learning-based AI prediction model that can anticipate the development of breast cancer up to five years in advance. This innovative technology, trained on over 90,000 mammograms and 600,000 patient outcomes, can accurately predict over 30% of all cancer patients in the highest-risk category compared to the 18% detected by current models. In developing its technique, MIT sought to address disparities in detection inequality among minorities; Black women are more than 42% more likely than white women to die from breast cancer, a statistic primarily driven by the lack of minority representation in current early detection techniques.

Kheiron – London-based Kheiron has developed a machine learning platform dubbed Mia. Mia analyzes standard mammography images to help radiologists decide whether or not a woman requires further evaluation. The company says the software has already shown success in a multi-center clinical study

Google/Hologic – Global medical device company Hologic is another early adopter of the imaging suite. The company is using Google Cloud’s offering to strengthen its diagnostic platform that screens women for cervical cancer. Hologic will store its images using the suite, and it will develop an AI model with Google Cloud to improve diagnostic accuracy for those cancer images.


Digital technologies in breast health – Some critical ideas for scaling up from pilot programs to full-scale implementation:

  • Technology is an enabler, but feedback from the people at the forefront of providing care, particularly nurses, is essential to scaling up pilot projects.
  • Equally important is making sure that the people using the technology are properly trained.
  • Implement quality monitoring protocols
  • Set up public-private collaborations
  • Identify and scale-up high-potential solutions: who’s out there working on new ideas?
  • Find people who know how to analyse data.
  • Build into projects the questions that will help provide the answers to scaling up a project: who do we need to talk to; what data will be needed to convince governments, investors, organisations to participate?
  • Scale isn’t just about reach: it’s showing that the technology can be adapted to the local environment.
  • Scaling up successfully means being able to convince investors that the environment you’re working in is viable.
  • Understand the local digital regulatory environment.
  • And finally: never lose sight of the patient’s needs throughout the process of scaling up a pilot project.

Innovations in mobile health and social media applications are occurring across the cancer spectrum, from primary prevention to screening, early diagnosis, treatment, survivorship, and end-of-life care. Thousands of health-oriented mobile sites and apps have already been developed with the advantages of low- or no-cost, high scalability, self-tracking, tailored feedback functionalities, use of images and video for enhanced health literacy, broad reach, and data sharing for large-scale analytics. More and more research demonstrates that digital health interventions can support and improve patient experiences and outcomes. For breast cancer patients and survivors, digital health technology can ultimately increase their chances of a good quality of life and positive health outcomes.

Can Digital Technologies Be Used To Support Public Health Programs?

“Medicine still overpowers public health, which never recovered from being ‘relegated to a secondary status: less prestigious than clinical medicine [and] less amply financed.”

Paul Starr, Sociologist
Image Credit: Shutterstock.com

A functioning, just society cannot sustain itself without public health. But the unfortunate product of a society with modest levels of commitment to the social contract and a jaundiced opinion of massive government budgets is underfunding and mistrust of public health. One might ask what could enhance public health without requiring comparatively huge budgets or much active participation by the public. The answer, as with every corner of modern society, is technology. Not just any technology, however, as the digital health tools available to large medical centers are prohibitively expensive for public health and not necessarily what public health needs to do an effective job. So, what would empower public health agencies and professionals?

Public health’s primary goals focus on protecting and improving the health of communities. Public health technology helps reach these goals with greater efficiency. When applied to public health situations, tech provides public health professionals with advanced tools to obtain accurate, detailed population data in real-time. This data can help them build more effective actionable health strategies covering a range of scenarios, from individual care strategies to coordinating support systems that can address widespread disease outbreaks.

Technology encompasses everything from life-saving devices to data-gathering tools, meaning that the synergy between technology and public health is multifaceted. While the following examples demonstrate this interaction in vastly different ways, they are all united by the goal of improving community health.


Geospatial Technology – Geospatial technology has a range of health care functions. Still, perhaps one of its most interesting might be its ability to provide information that can help improve public health. Geospatial technology collects information about several factors, analyzes the data, and displays the results on a multilayered map. For example, geospatial tech can provide in-depth information on disease penetration within a specific region, health risks by age demographic, care delivery logistics, and other social factors that influence population health. These multilayered maps can inform and educate professionals and the community about an area’s actual state of health care and allow decision-makers to improve the locations they govern.


Twitter Monitoring – Don’t laugh. Twitter has much more to offer than celebrity gossip and enticing food photos. Health care professionals are using the popular microblogging platform to monitor the spread of infectious diseases, including COVID-19, and predict disease activity. During flu season, researchers at universities across the country analyze millions of tweets containing the word “flu.” These researchers have found Twitter to be a more accurate monitoring tool for the disease than those used in the past, such as public laboratories and Google searches. According to health experts, the real-time information gleaned from Twitter is also more helpful because it is timelier. By receiving information nearly earlier, researchers can more accurately chart disease activity. Doctors can also access the information to make better treatment decisions during a health epidemic.


Wearable Technology – Wearable fitness bands allow users to track their movements throughout the day easily. Metrics such as total steps taken, heart rate, run or ride pace, or the amount and quality of sleep each night help individuals better identify, track, and achieve their health and fitness goals. For those who regularly use a wearable monitor, this information can be a reference point when communicating with health care providers about general wellness goals or other health markers. Health insurance providers have also taken notice and have built incentive programs to encourage the use of wearables. For example, UnitedHealthcare’s UnitedHealthcare Motion program allows its members to earn money toward out-of-pocket medical expenses by reaching walking goals. This metric can be monitored with a wearable device. Beyond fitness, wearable technologies are advancing to monitor vital statistics such as a user’s heart rate, lung function, blood oxygen level, and blood sugar. They are even being developed to track and alert the onset of degenerative conditions such as Parkinson’s or Alzheimer’s. A user could have the level of medication in their blood regularly monitored according to a physician’s plan and be reminded to administer their next dose when its level drops below a certain threshold.

I know what you are probably thinking. Wearable devices are pretty expensive. So how can they be used to support public health programs? There are ways to incorporate wearables into public health initiatives that don’t require a significant investment. One of the organizations that I love is called Recycle Health. RecycleHealth is a 501(c)(3) charity based out of Tufts University School of Medicine. They collect and refurbish fitness trackers to provide underserved populations with a method to maintain health and fitness. They’ve collected over 5,000 trackers over the past four years. They come from individuals who have unwanted trackers, as well as from vendors, organizations, and workplace wellness programs. They are sent from all over the world. RecycleHealth prides itself on finding trackers and new homes with people who benefit from their use but would not usually be able to afford or seek to purchase one. They provide trackers to underserved populations, including older adults in lower-income communities, veterans, homeless populations, and programs serving intellectually disabled adults. The work Dr. Lisa Gualtieri and her team are doing is critically important in providing these devices to people who would benefit from them. Organizations interested in donating or receiving devices can visit their website for more information.

This author also participated in a program within the local community where I live to solicit donations of recycled mobile phones, wearable devices, and Amazon Echo devices to support underserved communities during the pandemic, albeit on a smaller scale than Recycle Health. I can tell you from personal experience that they made a massive difference in helping people maintain their health, contact care teams to ask questions and receive treatment advice, and connect with loved ones and community support organizations to reduce loneliness and ensure that they were getting meals delivered.


3D Printing – At first, this might not seem like an appropriate choice for a public health application. 3D printing also became a vital asset in the public health response to the COVID-19 pandemic. Various 3D-printed devices and tools have been created to alleviate supply chain shortages, from swabs used for COVID testing to splitting devices that enable multiple people to use a single ventilator. While this technology might seem cost-prohibitive to some, the costs continue to decrease, and sharing the devices across various settings can even lower implementation costs.

This is another technology where the cost has come down dramatically. And, just as mentioned above, it can be done as a partnership play instead of a direct purchase. Public health organizations are partnering with technical colleges in their area to ensure they have access to 3D printers and can do so at little to no cost.


Telehealth – Cell phones, mobile devices, and PCs are helping connect patients with their practitioners. People too ill to attend a clinic, without adequate transportation, or without spare time can video conference with a trained health care practitioner through apps such as Doctor on Demand and NowClinic. Additionally, the health insurance industry’s significant players offer some form of telehealth in their health coverage options. Data amassed by Pew Research indicates that around 5 billion people worldwide have mobile devices, more than half of which are smartphones. Data from research firm Statista also shows that even people in lower annual income cohorts own and use a smartphone. (See graphic below).

Image Credit: Statista

And, as Recycle Health does with wearable technology, that’s exactly what a Maryland nonprofit organization called Secure the Call does. This organization has a mission to provide the millions of Americans who need phones for emergencies get them coupled with an environmental mandate to keep as many cell phones out of landfills as they can. Secure the Call says that they are the middleman by collecting the phones, processing them, and then getting them into the hands of the organizations that can distribute the phones where they are needed. Secure the Call works with 425 community partners to get the phones to the people who need them the most. Besides domestic abuse victims, the nonprofit also provides phones to seniors.

This demonstrates that telehealth can reach patients that traditional forms of health care do not.


For those interested in exploring the topic of connected communities of care, the best resource by far is this book: Building Connected Communities of Care: The Playbook For Streamlining Effective Coordination Between Medical And Community-Based Organizations by Dr. Keith Kosel, Vice President, and Dr. Steve Miff, President and CEO of Parkland Center for Clinical Innovation (PCCI). This book proposes a novel approach to the coordination of medical and social services through the use of people, processes, and technology, with the goal being to streamline coordination between medical and Community-Based Organizations and promote true cross-sector patient and client advocacy. The book is based on the experience of Dallas, TX, which was one of the first metropolitan regions to develop a comprehensive foundation for partnership between a community’s clinical and social sectors using web-based information exchange. In the five years since the initial launch, the authors have been able to provide seamless connection, communication, and coordination between healthcare providers and a wide array of community-based social service organizations (a/k/a Community-Based Organizations or CBOs), criminal justice entities, and various other community organizations, including non-collegiate educational systems. This is, in my opinion, the best resource to understand how to build a program that delivers the best outcomes for the communities you serve.

Geospatial technologies, social media monitoring, wearable tech, 3D printing, and telehealth are just some of the tools that medical professionals are employing to improve patient care and outcomes. While time will tell what other high-tech tools will revolutionize public health in the future, each of these current and evolving public health technologies has the potential to impact a community’s health and well-being profoundly.

Is Femtech the Next Big Growth Opportunity in Health Care?

“The market potential is huge. There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

Michelle Tempest, Partner, Candesic
Image Credit: Shutterstock.com

Women’s healthcare enables better outcomes for women patients and consumers. Although women represent half of the planet’s population, tech companies catering to their specific health needs represent a minute share of the global technology market. This disparity is staggering, especially since women spend an estimated $500 billion a year on medical expenses, according to PitchBook. Tapping into that spending power, many apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility and offering solutions for pregnancy, breastfeeding, and menopause.

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In the course of just a few years, it has grown to encompass a wide range of technology-enabled, consumer-centric products and solutions, including maternal health, menstrual health, pelvic and sexual health, fertility, menopause, and contraception, as well as several general health conditions that affect women disproportionately or differently (such as osteoporosis or cardiovascular disease).

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company.

According to McKinsey, depending on scope, estimates for FemTech’s current market size range from $500 million to $1 billion. Forecasts suggest opportunities for double-digit revenue growth. In analyzing the current market, they found concentration in maternal health patient support, consumer menstrual products, gynecological devices, and solutions in fertility. Yet this is clearly, and promisingly, only the beginning of what FemTech can address. As they show in the graphic below, there’s still a lot of “white space” available for companies to develop more solutions to fill current gaps in the global market.

Image Credit: McKinsey, February 14, 2022

Another company, FemTech Analytics, estimates that the global FemTech Market Size accounted for $40.2 billion in 2020 and is projected to grow at an average CAGR of 13.3% from 2020 till 2025 to reach $75.1 billion. Despite increasing interest in recent years, the industry remains underestimated and has high growth potential. They show the market segmentation and distribution across the various segments in the graphic below:

Image Credit: FemTech Analytics

And within those various segments, FemTech Analytics has identified the product types as seen in the graphic below:

Image Credit: FemTech Analytics

What I love about FemTech Analytics’ market research reporting is that they’ve created a MindMap of all the companies that make up the FemTech market as of the end of 2021. You can access that MindMap here.


Some examples of companies developing products in the FemTech market include Clue, Elvie, MobileODT, Lattice Medical, and EndoDiag. Here’s a brief look at each company.

Clue – I mentioned Clue and its founder earlier. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet. Clue allows women to do exactly that with a few taps on their smartphones.

Image Credit: Clue

Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Pelvic floor/kegel exercises have had known benefits for women for decades, especially post-childbirth, for strengthening bladder muscles, reducing the risk of pelvic prolapse, and improving sex. It’s the same core strength promise of popular activities such as pilates and yoga but without the easy availability of motivating group exercise classes. The wearable — for indeed, when in use, it’s ‘worn’ inside the body — has a companion iOS app that offers five-minute workouts to help the user learn how to exercise their pelvic floor muscle correctly and build up its strength, tracking progress within the app via a personal LV score.


MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence identifies normal or abnormal cervical findings. A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.)

Image Credit: MobileODT

Lattice Medical has developed a 3-D printed hollow breast implant that allows for tissue regeneration and is absorbed by the body over time. Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant and eventually fills it out. In the meantime, the 3-D-printed shell disappears altogether 18 months later. This product is in the very early stage of development, however. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025.

Image Credit: Lattice Medical

EndoDiag is a French medical technology company that allows early diagnosis of endometriosis and better management of the condition. Despite significant advances in non-invasive diagnostic methods, including imaging techniques such as ultrasound, MRI, or CT scans, currently only the removal of endometriotic lesions via laparoscopy under general anesthesia and their histological analysis enables the diagnosis of endometriosis with certainty. The average delay between disease onset and its effective diagnosis is estimated between 7 to 11 years. This significant delay due to the lack of a non-invasive diagnostic test leads to frequent misdiagnosis and associated unsuitable treatments, as well as to more severe cases as the disease may progress and damage other organs. They’ve developed a test called EndoDTect®, a blood test based on the analysis of a combination of biomarkers. Changes in their expression levels indicate if a subject has endometriosis or not. Combining high sensitivity and specificity, EndoDTect® has the potential to reduce diagnosis delays dramatically. Endodiag is currently conducting validation studies to confirm the predictive value of EndoDTect® for disease detection.


My take – Companies have a tremendous opportunity to develop products and services in this space and a willing audience ready to take advantage of them. Early movers can stake out opportunities in prominent white spaces identified in the McKinsey research, including by leveraging technology to address women’s health issues beyond reproduction and by helping to meet the needs of underserved populations such as low-income or minority communities. I think there are multiple use cases where FemTech will play an increasingly important role in the future. These include:

  • Improving care delivery: Virtual clinics such as Tia, innovative brick-and-mortar clinics such as Kindbody, and direct-to-consumer prescription delivery services like those of The Pill Club all enable women to access care in a more convenient, consumer-centric manner.
  • Enabling and supporting self-care: Trackers and wearables offered by companies such as Bloomlife, and at-home diagnostics like those provided by Modern Fertility, are among the FemTech solutions that are helping women take greater charge of their health and health-related data.
  • Improving diagnoses: Clinical diagnostics companies are pushing the scientific frontier to address unmet medical needs in areas such as endometriosis (DotLab) and preterm birth (Sera Prognostics).
  • Addressing areas that are often stigmatized: Companies are addressing what had been considered to be stigmatized topics head-on, such as menstrual health (Thinx), sexual health (Rosy Wellness), pelvic care (Elvie), and menopause (Elektra Health).
  • Delivering tailored care to underserved populations and culturally sensitive care: Solutions tailored for subpopulations are emerging for Black women (such as Health in Her HUE), LGBTQ+ populations (FOLX Health), and women in low- and middle-income countries (Kasha).

“Women Buy, Women Rule” – So says business guru Tom Peters. I couldn’t agree more. Because women are not just consumers but the primary healthcare decision-makers for themselves and their families, better health outcomes for women can lead to better outcomes for society. As women’s healthcare becomes an increasing priority, FemTech is rising to meet the challenge as it matches capital and talent with unmet needs. In a short period of time, FemTech has already demonstrated impressive early wins. And the actual disruption in the market lies ahead.

Will NFTs Be Used In Health Care?

“All in all, even though NFTs are still in their infancy, the technology might evolve in the future to become more compelling for patients to favor the agency it provides over their data.”

Dr. Bertalan Meskó & Dr. Pranavsingh Dhunnoo, The Medical Futurist.com, January 13, 2022
Image Credit: Shutterstock.com

Yesterday, Dr. Bertalan Meskó & Dr. Pranavsingh Dhunnoo published a thought-provoking article on The Medical Futurist website speculating whether NFTs might play a role in health care by allowing patients to monetize their health data. Here’s a link to their article.

I’ve long admired the work being done by Dr. Mesko and his team at The Medical Futurist Institute. This article had my head spinning. We’ve all heard the hype about NFTs for some time now, usually associated with some artwork or other collectible. But until this article, I had not given much thought to whether NFTs would be used in health care. I’ve written about the underlying technology of blockchain before. I understand the point the authors are trying to make here, and I agree with the potential to empower patients to control the use of their health data. However, I’m conflicted trying to balance the potential of the technology with the impact that NFT-mining has on the environment.

First, some basics for those unfamiliar with NFTs. NFTs (Non-Fungible Tokens) are defined as “unique, digital items with blockchain-managed ownership,” per NFT marketplace OpenSea. In short, NFTs represent digital assets — which can range from images to songs to videos to tweets to patient data — that are verified through blockchain technology. Owning NFTs allows individuals to claim exclusive ownership over these digital assets. Crucially, NFTs offer a way to monetize digital goods by authenticating their scarcity and provenance.

A debate has arisen over what ownership means in the context of NFTs. In many transactions, NFTs don’t represent the actual asset itself (nor IP nor reproduction nor copyright) but are solely a record of ownership. Despite the ballooning hype, the tech isn’t new. In 2017, people spent millions buying and selling “CryptoKitties,” digital collectible cats created by Dapper Labs, some of which sold for more than $100K.

As reported by CB Insights, several NFT marketplaces have emerged to capitalize on the soaring demand. OpenSea, for example, recently raised $23M led by VC firm Andreessen Horowitz. Other names in the space include Sorare, SuperRare, Nifty Gateway (which was acquired by Gemini), MakersPlace, Decentraland, Rarible, and more.

In health care, as Dr. Mesko points out, NFTs could be used to allow patients’ genetic data to be minted as NFTs, so the information will come with an inherent feature to be tracked. You would be able to see where it ends up and hold those who used it without your permission accountable since you are the sole owner of the data, as certified by the NFT authentication. Moreover, the NFT owner can enable a feature to earn money whenever a transaction occurs with the data. Think of companies like 23 and Me who are using the tremendous amount of genetic data they have amassed by selling their kits to conduct drug discovery for which they might make billions – while you get nothing, even though it’s your information.


A non-digital example in the news recently was the case of Henrietta Lacks. In 1951, Henrietta Lacks, a Black mother of five who was dying of cervical cancer, went to Johns Hopkins Hospital in Baltimore for treatment. Without her knowledge or consent, doctors removed a sample of cells from the tumor in her cervix. They gave the sample to a researcher at Johns Hopkins University who was trying to find cells that would survive indefinitely so researchers could experiment on them. They were reproduced billions of times, contributed to nearly 75,000 studies, and helped pave the way for the HPV vaccine, medications used to help patients with H.I.V. and AIDS, and, recently, the development of Covid-19 vaccines.

Last October, 70 years after Ms. Lacks died at Johns Hopkins Hospital and was buried in an unmarked grave, the World Health Organization honored the contribution she unknowingly made to science and medicine. During a ceremony in Geneva, Dr. Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., presented the Director-General Award to Ms. Lacks’s son Lawrence Lacks. He was 16 when his mother died on Oct. 4, 1951. On Oct. 4, 2021, her descendants sued Thermo Fisher Scientific, a biotechnology company they accused “of making a conscious choice to sell and mass-produce the living tissue of Henrietta Lacks,” according to the federal lawsuit. The family said it demanded that Thermo Fisher pay $9.9 million and “disgorge the full amount of its net profits obtained by commercializing the HeLa cell line” to Ms. Lacks’s estate.

Proponents of NFTs argue that their use would prevent what happened to Henrietta Lacks to anyone else, especially in today’s world of genomic data and CRISPR technology.


Here’s my dilemma – I’m having trouble reconciling the potential benefits versus the immense environmental impact of proof-of-work (PoW) blockchains. The annualized carbon footprint of the Ethereum network alone is estimated to be almost 16 megatons of CO2 — comparable to the carbon footprint of Lithuania — while it consumes 34 terawatt-hours of electricity, similar to the power consumption of Denmark, per Digiconomist. As such, NFTs might not be outright commercially viable soon. But alternatives for NFT minting are in the works that could use a fraction of the computing power currently involved in their transactions. Then there is the issue of whether companies offering digital health services will want to adopt the technology. They might not be particularly excited by the idea of sharing their profits with patients. I admit that I’m not a big fan of cryptocurrency, so that’s probably coloring my opinion on this topic. I don’t think that NFTs will dramatically impact health care any time in the near future. Lots of hype. Lots of challenges. And sharing potential revenues with patients isn’t in the corporate DNA of life sciences companies – and won’t be any time soon.

Health Care Disruptors to Watch in 2022

“Futuristic and disruptive technology implementation should be a key goal for every business. It ensures an efficient, intelligent, data-driven yet secure environment.”

Ashwin Muthiah, Chairman, AM International
Image Credit: Shutterstock.com

One of my favorite thought exercises during my fifteen-plus year tenure at Sg2 was to sit in a conference room at the end of every year with ten to fifteen really smart people (news flash – all my colleagues at Sg2 are really smart people, and I’m almost over my Imposter Syndrome) and have a spirited discussion on what we would include in our annual Disruptors to Watch webinar in January.

After doing that for so long, the exercise almost becomes a part of your professional DNA. So, in Q4 every year, I start looking at all of the Tech Trends for the next year online and thinking about what will rise to the top of my list. Unfortunately, you won’t get the collective benefit of my friends at Sg2 here, just one old guy’s opinion about the potential key technology disruptors in health care for 2022.

Before I begin, however, I want to acknowledge some thoughts shared by Nick Neral, Director, Panda Health, in a LinkedIn post this past week:

“If you research digital health trends of 2022, depending on the website, you’ll find “beyond” telemedicine, home health, digital therapeutics, predictive analytics and more. If you ask health systems what they’re actually working on the answer is very different…..Implementing nothing. (Yes, many don’t have the resources for anything new)….The digital health trend in 2022 and 2023 is going to be how can we do more with less.”

Nick Neral, Innovation & Strategy Director, Panda Health, LinkedIn post, December 9, 2021

I agree with Nick’s comments. He’s spot on here. In this environment, it’s challenging to try and implement new technologies when you’re running as hard as you can to handle the flood of patients jamming your ER and ICUs in the middle of a pandemic. My intention here is not to promote technology for technology’s sake, but to highlight technologies that I believe can remove some of the onerous administrative burdens we place on our front-line professionals and give them time back to do what they went into the profession for in the first place – care for patients and their families.

With that said, after working through my list of over fifty technologies that I’ve been tracking in 2021, here are my top picks for the coming year.


Voice technology takes center-stage

“We are at a very interesting time for healthcare and voice technology, because of the computing power. We’re already starting to see some radical changes in the way we experience the healthcare journey,”

Teri Fisher, physician and clinical assistant professor at the University of British Columbia

I’ve written on this topic earlier this year. Since that July post, however, there have been several announcements that lead me to believe that 2022 will be the year that voice technology sees broader adoption. There have been advances in the ability for voice technology to advance telehealth progress, notably that a mix of modalities – between chatbots, text, and voice – will provide patients with the right tool for the right time in the right place. Dr. Fisher, quoted above, is the author of an excellent book on Voice Technology in Healthcare, published by HIMSS, that I highly recommend if you want a deep dive into the topic.

But why now? I believe three significant drivers will push this into the mainstream over the next twelve months: technology evolution, the ongoing pandemic, and big tech moves in health care. Let’s take them one at a time:

Voice technology evolution – As noted in the quote above, increases in computing power have accelerated the use of voice-assisted technology in health care. The global smart speaker market is poised to see a continued annual growth rate of nearly 24 percent through 2023, according to research by Technavio. Researchers expect massive market growth in the biomarker segment alone, reaching 147.59 billion USD by 2028. (For an excellent overview of this segment, here’s a link to a post from The Medical Futurist) An IHS Markit Technology report predicts more than 900,000 such devices will be used in healthcare by next year, and diverse initiatives are already in motion. Combining voice technology with AI and machine learning and coupling those with edge computing and faster 5G networks, you have a perfect storm for increasing adoption at multiple points along the care continuum.

The ongoing pandemic – Beyond just the use of voice-enabled chatbots and voice-enabled telephone triage systems, the pandemic has forced families to manage their health care issues, including dealing with kids or parents at a distance. This has created the demand for deploying smart speakers in the home, school, assisted-living facility, or other care locations to enable an easy, zero-user-interface way for loved ones to initiate calls, monitor activity, or deal with emergencies. Physicians have increased their use of voice-enabled technology to create visit records, thus minimizing the additional work required to complete EHR notes for patients.

Big tech moves – Last year, a pilot project at Cedars-Sinai placed 100 Amazon Echo devices in patient rooms throughout the hospital. Using an Alexa-powered platform, users may speak to access entertainment options and, if needed, request staff assistance. Boston Children’s Hospital targets parents with KidsMD, an Alexa skill that offers information about common ailments and medication dosing. Another, the Mayo Clinic First Aid skill, was launched by the Mayo organization to suggest care tips for non-emergency situations. Atlanta-based Thrive Senior Living is leveraging Google and Amazon smart speakers to support a custom suite of applications that route requests and questions to care teams. A test run found that residents liked the approach, and employees came better equipped to assist patients thanks to the information they received on a connected mobile app. And finally, in my Tech News This Week post last Saturday, I reported on Amazon’s announcement of their new direct-to-consumer subscription offering, Alexa Together, aimed at families caring for elderly members who are still living independently but need extra support. Here’s a short video highlighting how BayCare implemented Alexa devices in 2,500 patient rooms across 14 hospitals:

Video Credit: BayCare Health System, posted December, 2020

And, just yesterday, Microsoft announced it is shelling out a hefty $19.7 billion for Nuance Communications, a pioneer in voice recognition and natural language understanding, to bolster its ambitions in the healthcare market.

All of these point to 2022 being a significant inflection point in using voice-enabled technology in health care.


At-Home Lab Tests

This is another area that has seen rapid growth and development over several years. And the pandemic requirement for ongoing testing for COVID-19 got patients used to going to their local pharmacy and buying in-home tests regularly. Patients can access a wide range of analyses determining their lab markers and blood results. No need to meet anyone, go anywhere.

And there are countless at-home lab tests already cleared by the FDA. Here’s a link to the FDA database of cleared, over-the-counter lab tests. The rise of companies like imaware, EverlyWell, LetsGetChecked, Health Testing Centers, UltaWellness, Walk-In Lab, and MyLabBox has spurred continued growth in this area. For example, the imaware platform provides over 20 different types of advanced home-based health tests. The company also offers telemed physician oversight, helping people control their health. During the pandemic, they launched a collaboration with virtual care company Wheel to deliver clinician-administered at-home COVID tests. They will indeed have more ideas under development. Patients can get easy access to dozens of at-home tests. Here’s a link to the kits available from mylabbox.

Here’s a link to a comparison of Best Blood Tests based on In-Depth Reviews from Consumers Advocate.org

With market growth calculated to value over $7.6 billion by the end of 2028 and a CAGR of over 5.4% during the forecast period of 2021-2028, it seems clear that these will have a significant impact on testing and care coordination in the coming year.


Health Systems Data Companies – Data as the new health care currency

We’ve been hearing about big data and data as a strategic resource for over a decade now. But, there have been developments over the last eighteen months that signal that the industry has awoken to the fact that the trove of data they are sitting on is valuable and an asset to be mined.

Case in point – Truveta. Twenty of the largest U.S. health systems, led by Providence, have formed a startup to pool patient information, aiming to streamline efforts to analyze anonymous data to improve care, develop better therapies and drugs, and promote more equitable treatment of underrepresented groups. The Seattle-based startup is led by former Microsoft Corp. executive Terry Myerson, who ran the software maker’s Windows business. As of this writing, Truveta partners with around 20 medical providers, aggregating regular de-identified data from 42 American states and myriad patients representing about 16% of all U.S. clinical care into its collection. It has built a software service that allows researchers and other users to ask questions about the collected data. Here’s a short video featuring the Truveta Health System founders discussing their vision for saving lives by using data:

Video Credit: Truveta

“We want to allow people to study human health. When they do, we want to make sure they’re a studying data set that’s consistent with the whole population. The transparency, the data on the data, is something fundamental we want to bring to the table.”

Terry Myerson, CEO, Truveta, Health Evolution interview, February, 2021

Another example that generated a firestorm of protest and even led to a Federal investigation was Ascension Health’s partnership with Google. Ascension and Google say the project could lead to better outcomes for patients. Privacy experts also said it appears to be permissible under federal law. But one professor told the Journal “the optics are bad” because patients and doctors weren’t informed, and several U.S. senators expressed concern. It is unclear what the departure of Dr. David Feinberg to head Cerner means for the arrangement if anything. But the partnership is another example of the accelerating trend to aggregate, de-identify, mine, and monetize these vast data resources.

Want more proof? Beckers Healthcare did an outstanding job of reporting on the growth of these partnerships in 2021. As of their June posting, they identified 38 Big Tech partnerships in healthcare this year: Amazon, Google & more. The “horse is out of the barn” on this one. So don’t expect any slowdowns in the area in 2022.


Digital Health Insurance

Digital has begun to reshape health insurance markets. According to McKinsey, payers in the United States have been slow to digitize. They are still behind other industries in their use of artificial intelligence and automation, as well as in customer satisfaction. They’re now starting to catch up. Both incumbents and disruptors are making substantial and growing investments in digital programs.

Just last month, Bain Capital announced that Enhance Health, LLC, a new technology-enabled, digital health insurance brokerage and care navigation platform focused on serving the Medicare Advantage market, launched with $150 million of total capital. Headquartered in Ft. Lauderdale, Florida, Enhance Health will serve both the Medicare and individual and family plans segments of the health insurance market.

And, Enhance Health is not alone. Digital Insurance is another digital-first insurance company now adding healthcare to its portfolio of offerings. OneDigital went to market as the new generation in health and benefits. Focused on creating harmony between people and technology, today, OneDigital delivers benefits solutions, including a sophisticated combination of strategic advisory services, analytics, compliance support, technology, and HR capital management tools.

And, of course, there’s Oscar Health. Oscar Health Insurance began in 2012 and offers health insurance to residents of Arizona, California, Colorado, Florida, Georgia, Kansas, Michigan, Missouri, New York, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Iowa, Oklahoma, and Virginia. Coverage may soon be available in other states. The Oscar app is downloadable and compatible with Android and iOS. The app offers 24/7 doctor-on-call services. The company operates in partnership with Mount Sinai Health System. The company provides health insurance wellness incentives for being active, tracked using free wearables. There are low-deductible options available. There are five tier plans—secure, bronze, silver, gold, and platinum—covering between 60% and 80% of medical expenses.

“Ten years from now, I think we’ll have contributed to lowering health-care costs, and that remains our far end goal and what we do everything at Oscar.”

Mario Schlosser, CEO, Oscar Health, Interview, Yahoo Finance, March, 2021

There are real benefits that will continue to drive these developments. Those payers that invest thoughtfully in human-centric digital transformation are beginning to see the value, including material changes in member satisfaction and trust, increased revenue from digital branding and improved sales tools, and double-digit reductions in administrative costs. In addition, stronger member relationships are often leading to lower medical costs. Watch this space…..


Cognitive Automation Takes On Administrative Work

Cognitive automation is a new and fast-emerging technology in digital transformation. It is one of the key IT trends in healthcare, and its popularity is expected to increase in 2022. Cognitive automation generally combines natural language processing, machine learning, and computer vision technologies into a platform to increase decision velocity in health care.

This technology makes it possible to process zettabytes of data within seconds, thereby providing decision-makers with recommendations readily available and backed with real-time data. The end goal of this emerging healthcare technology is to establish a self-driving enterprise whereby operational processes are automated.

Cognitive computing has also enhanced patient engagement and improved access to services. Researchers are leveraging the potential of cognitive systems to make clinical trials more comprehensive and valuable, making this a critical technology development in health care. Key players operating in the cognitive computing in the healthcare market include Apixio, MedWhat, Healthcare X.0, Apple Inc., Saffron Technology, Inc., Nuance Communications, Inc., Google LLC, Microsoft Corporation, and IBM Corporation.

“Technology should work for people, not the other way around.”

Brad Becker, former Chief Design Officer for IBM Watson, Knowledge@Wharton interview, November, 2014

The global cognitive computing and analytics market has been projected to be valued at $95 billion by 2022, at a Compound Annual Growth Rate (CAGR) of 42.9% during the forecast period. North America, followed by Europe, is expected to be the most significant revenue-generating region for the cognitive analytics vendors in the next five years. So, a lot of investment in the space coupled with a pressing need to remove some of the administrative and operational burdens from the shoulders of front-line health care professionals will drive the growth in this area over the next eighteen to twenty-four months.


2022 will be another challenging year in health care. We’ll still see pressure on our systems from the ongoing pandemic. Investments in new technology will be constrained because of financial and resource availability. I’m betting that many posts you’ll see from me next year will focus on the issue of – time: giving time back to our frontline professionals to provide care, having patients spend less time navigating the complexities of our crazy health system, reducing the time to diagnosing and treating diseases, and creating time to allow everyone to achieve a healthy balance in our lives. If any of the technologies I’ve listed above can help us accomplish that, we all win.

Digital Health: What We Can Learn From Other Countries Experiences

“Twenty percent of Estonians will have used our DNA analysis service by the end of this year and know which diseases they are susceptible to and how they can take appropriate precautions.”

Kersti Kaljulaid, Former President, Estonia – Interview in Der Spiegel
Image Credit: Shutterstock.com

Last week I received a book recommendation based on my previous reading on my Kindle device. The title was: The Year in Tech 2022: The Insights You Need from Harvard Business Review. I immediately purchased and downloaded it. Chapter three caught my eye – Want to See the Future of Digital Health Tools? Look to Germany. The chapter summarizes an online HBR article published the previous year (more on Germany later). And it got me thinking about whether there might be additional lessons to be learned from other countries as well. So, I set off to do some research. It turns out we can learn a lot.


The lead quote for this post, from the former President of Estonia, was a real eye-opener for me from a country we rarely discuss. Imagine a country where citizens will have their genetic profiles integrated into the digital health system with individual risk scores and pharmacogenomic information. When they go to the doctor, they will get fully personalized, genetic risk-based diagnosis, medication, and preventive measures. Estonians are very comfortable using e-services and sharing their data when necessary. Citizens are brought up with the philosophy that they own their data. However, it’s both the public and private sector’s job to use this data in the best way possible—to run their shared services smoothly and improve life in Estonia. Some essential facts:

  • In Estonia, 95% of health data is digitized
  • 99% of prescriptions are Digital
  • 100% of billing is done electronically
  • 94% of citizens are covered by national healthcare

They started to build their digital health system 20 years ago, and within the next few years, the Baltic country will reap the benefits of a transparent, blockchain-based, digital health system hooked on genetic data. The first fully digitized republic certainly sets the direction for other countries to follow. How have they done it? During the last twenty years, project e-Estonia has wired up the entire Baltic nation. The specific services that the government is involved with, legislation, voting, education, justice, banking, taxes, policing, and, naturally, healthcare, have been digitally linked across one platform, X-Road. Citizens can vote through their laptops, sign contracts with their digital signature, or use their chip-IDs when surfing around in the business and land registry – knowing that their data is secured through the blockchain and open to everyone. By having 78.1 percent of public bureaucracy digitized, the country also saves around 2 percent of its gross domestic product. For a deeper dive into the Estonian digital health experience, check out this excellent post from Dr. Bertalan Mesko and his team at The Medical Futurist Institute.


Next, let’s look at Finland, which ranks among the three strongest health technology economies globally. For centuries Finland has been collecting data precisely. And they also have been working for a long time to have their health and social care data digitized and harmonized. Finland has the National Data Exchange Layer, the equivalent of the Estonian X-road (starting to see a pattern here?). The interesting thing about this is that data can be exchanged, even between these two countries. They also have Kanta/My Kanta for Health data. These services are widely used by patients, even though they are relatively new. The system grants access to all healthcare information that the public system has about the person enquiring. People can renew electronic prescriptions, view records related to their treatment, store their living wills and organ donation testament, and consent to or refuse the disclosure of their personal data.


How about Denmark. The world’s third happiest country has one of the most advanced digital health systems alongside an elaborate and concise national digital health strategy for the next four years. The document emphasizes the importance of the cooperation of every healthcare actor through the easiest and fastest way, technology, with a clear purpose: to build an integrated network focusing on patients and looking at the person as a whole, not just at the individual diagnosis. Information on causes of death has been collected since 1875, and cancer incidence has been registered for the whole country since 1943. The Danish National Patient Registry has been keeping records that date 30-40 years back, making it one of the oldest nationwide hospital registries globally.

Another area where Denmark invests heavily is genomics-powered precision medicine – and things are moving fast. The Danish parliament adopted the law to establish the National Genome Center in 2018, and they built up their dedicated supercomputing infrastructure in 2019, began large-scale whole-genome sequencing to build up their accompanying genome database in July of that year. They believe that within the next five years, they will at least do 60,000 whole-genome sequences – at a minimum. Once again, The Medical Futurist Institute gives us a deeper understanding of the situation in Denmark in this post.


The health system in Sweden is founded on the principles of equal access and regional autonomy. Sweden recently updated its national eHealth vision, which now states that, by 2020, all residents aged 16 or over should have access to all health-related information documented in county-funded health and dental care. Two things enable this; a national patient portal and a national health information exchange platform. Although the county councils are autonomous and can prioritize which eHealth services to focus on, the decision was made at a national level that patients should only have one way to reach healthcare. A national patient portal, ‘1177.se’, is available for anyone seeking healthcare or health-related information in Sweden.

Sweden has chosen to implement a national Health Information Exchange (HIE) platform to facilitate the communication between different health information systems and eHealth services. The national HIE platform enables a single point of connectivity for client applications, making all Swedish EHRs appear like a national, virtual EHR. And citizens are responding. Preliminary results of a national patient survey among PAEHR users in Sweden indicate that the overwhelming majority of patients who have accessed the PAEHR are positive about it. Almost 90% of respondents completely agreed, and 8% partly agreed with the statement, “Having access to ‘Journalen’ is good for me.”


Now back to Germany – In late 2019, Germany’s parliament passed the Digital Health Care Act (Digitale-Versorgung-Gesetz, or DVG) — an ambitious law designed to catalyze the digital transformation of the German health care system, which has historically been a laggard in that area among peer countries. The timely introduction of the DVG means that Germany is poised to set an example for other countries in seeing what works (and what does not) in the adoption and diffusion of digital technologies for improving patient outcomes.

Perhaps the DVG’s most important provisions are its formalization of “prescribable applications” (Digitale Gesundheitsanwendungen, or DiGA), which include standard software, SaaS, and mobile as well as browser-based apps, and the creation of the Fast-Track Process, an accelerated regulatory path for companies to take their digital health applications to market. Following a streamlined review, an app can be added to a central registry of apps that can be prescribed by physicians and psychotherapists and will be reimbursed by all of Germany’s statutory health insurance providers, which cover 90% of the population of roughly 73 million individuals. The Fast-Track Process is run by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, or BfArM), which plays many of the same roles in Germany that the FDA does in the United States); BfArM also maintains the DiGA registry. The first five apps have already been added to the registry and offer support for patients to manage conditions including tinnitus, obesity, agoraphobia, osteoarthritis, and insomnia.

DVG promises to provide a standard care environment for manufacturers of new digital health tools to evaluate pricing strategies and understand how digital health applications fit into health care practice and patients’ everyday routines. The importance of such a major country mandating that all insurers have to pay for digital health apps is hard to overstate. With at least 50 apps currently already in the Fast-Track process and hundreds expected over the coming years from manufacturers worldwide, evaluation studies will create a wealth of data on how digital tools for remote patient care work in practice, which other payers and health systems can learn from. They will also be valuable in convincing health care providers — for whom evidence is of paramount importance — of the value of digital tools, both generally and in particular use cases.

Here’s a recently published update on the German DiGA journey with data through November, 2021.


So what can we learn from these examples? – There are several common elements to these national digital health programs that we could benefit from. But, and this is a crucial challenge, we would have to make major structural, payment, regulatory and legislative changes to how we currently operate. Here are my three major observations:

Interoperability is essential – Whether it’s X-Road in Estonia, My Kanta for Health in Finland, the National Patient Registry in Denmark, or 1177.se in Sweden, the data is interoperable and accessible across all sites of care, and in some instances, across country borders. Contrast that with our experience. Ask the question: “What have the American people gotten for their $35 billion HITECH investment?” The answer is not much. Silos abound. Compiling a single, comprehensive patient record is impossible. We have no national patient identifier to prevent mixing patient records. Cybersecurity is dismal at best. All of this is in a country that spends more than 17% of GDP on health care and has an administrative overhead estimated to be over 8%.

Image Credit: OECD, 2019

Patients own their health and genetic data – Most citizens in the countries discussed above are brought up with the idea that they own their data, can control who has access to it and for how long. In those countries that are doing genetic profiles of their citizens, the patient controls the information and its use – in some instances, using blockchain technology to maintain security and authorization of access. Here, the accepted norm is that your provider “owns” your data. And although you can request a copy of your patient records, you’ll likely be charged for the privilege and will either receive the information in paper form on a disk that is of little use. While patient data advocates like Dave deBronkart Jr, widely known as e-Patient Dave, a cancer patient, and blogger who, in 2009, became a noted activist for healthcare transformation through participatory medicine and personal health data rights, and others push for this, progress is slow.

“Owning a copy of your personal data does not change property law, medical record requirements, or hinder the advancement of science. But it does build health equity by giving everyone equal access to their lifetime medical data.”

Juhan Sonin, Annie Lakey Becker and Kim Nipp, Stat First Opinion, November 15, 2021

Data ownership gives each of us the keys to our health puzzle and insight into how our data is used outside medical appointments to further research, innovation, and better health care for all. It gives us the keys we need to care for ourselves and our loved ones, and to build health in our communities and our country at large. Data ownership unlocks the path to achieving our health and wellness potential.

Including an individual’s genetic information is critical to personalized care. – In addition to Estonia, the NHS in the UK, Iceland, and the UAE have plans to sequence the DNA of large segments of the population to make citizens’ lives better. Here in the U.S., Boston Children’s Hospital had a five-year program where parents of newborns had the option of having the child’s DNA sequenced to test whether that information helps guide the care of babies and monitor how pediatricians and parents react to knowing it. Phase 1 of that study wrapped up in 2019. These plans likely won’t be perfect at first. But other nations looking to implement their systems might build off those, and citizens will be the ones to benefit.

Digital health tools development is a complex, multifaceted, and highly dynamic environment. While significant implementation challenges remain, I’m confident that there is a better chance of preparing for whatever is coming next by demonstrating the best practices of how other governments, regulators, and developers tackle the challenges of today.